Monday, April 27, 2009

News Clipping Archives

 

Maryland / Regional

Md. braces for swine flu, opens command center (Hagerstown Herald-Mail)

D.C., Md. hospitals say nursing shortage no more (Daily Record)

Catania/Whitman-Walker Melee Gets Bloodier (Washington Post)

Homeless face growing demand for housing (Baltimore Sun)

2010 census undercount could cost state federal funding (Cumberland Times-News)

Suburban, Johns Hopkins to merge health systems (Daily Record)

 

National / International

Questions And Answers About Swine Flu (Washington Post)

Q&A: What you should know about swine flu (Baltimore Sun)

U.S. health emergency declared over swine flu (Baltimore Sun)

Dept. of Homeland Security Secretary Janet Napolitano Holds Press Conference on Swine Flu (CQ Transcripts Wire)

Swine flu prompts EU warning on travel to US (Washington Post)

Swine flu cases in US; agents checking borders (Associated Press)

A.D.H.D. Drugs Linked to Higher Test Scores (New York Times)

Doctors urge baseline test for prostate cancer (Baltimore Sun)

Taking a bite out of the bed-bug problem (Baltimore Sun)

 

Opinion

Swine Flu (Washington Post Editorial)

Reforming Health Care (Washington Post Editorial)

Connect to protect (Baltimore Sun Commentary)

Don't Weaken the Doctor-Patient Bond (Washington Post Letter to the Editor )

 

 

Maryland / Regional

 

Md. braces for swine flu, opens command center

 

Associated Press

Hagerstown Herald-Mail

Monday, April 27, 2009

 

BALTIMORE (AP) — Maryland officials are urging common sense steps to avoid swine flu.

 

State Health Secretary John Colmers says if people feel sick, they should stay home. Doctors are to monitor patients with flulike symptoms and send samples for testing.

 

Colmers says there are no Maryland cases reported, although a few tests are pending.

 

Dr. Frank Calia of the University of Maryland Medical Center says there’s no reason to be concerned about contact with Mexican immigrants because the virus has an incubation period of one to three days. That would affect only people who have recently traveled from Mexico.

 

State officials say Maryland has plenty of anti-flu drugs. As a precaution, the federal government has sent 200,000 doses to Maryland, which already had 276,000.

 

Copyright 2009 Hagerstown Herald-Mail.

 

D.C., Md. hospitals say nursing shortage no more

 

Associated Press

Daily Record

Monday, April 27, 2009

 

For the first time in at least 10 years, nurses are struggling to find jobs because of an economy that has fewer people being treated at hospitals.

 

Nurses are now working longer to avoid retiring and many nurses have rejoined the work force as the economy declined and jobs started to become scarce. That's the opposite of the way it was for the last 10 years when hospitals struggled to find enough nurses to have a full staff.

 

That's the way it was when Sue Estes quit nursing to raise her two children.

 

She never worried about getting another job as she heard of high salaries, signing bonuses and other benefits. None of those could be found — neither could a job — when Estes tried to go back to work.

 

"I've shipped out resumes everywhere, and I'm not even getting the courtesy callbacks," said Estes, 43. "I've actually been shocked that some places wouldn't even talk to me," she said.

 

The nursing industry right now says it only needs acute-care and emergency-room nurses. Luckily for Estes, she has some experience in those areas and she's hoping to work nights at St. Mary's Hospital in Leonardtown. Currently, she's volunteering at Anne Arundel Medical Center and has taken a nursing refresher course.

 

Skip Margot, vice president of patient care services at Shady Grove Adventist Hospital in Rockville, said there are only a few openings among his staff of 800 nurses.

 

"We started to see a real uptick in January, February and March," Margot said of nursing applicants. "We're seeing more men and women who are well-seasoned in their career. Their spouse now being out of work or the children now grown, they're willing to take a refresher course and work modified hours."

 

Most of the openings in the Inova Health System in Alexandria, Fairfax, Fair Oaks, Loudoun and Mount Vernon are in critical care, according to Bob McWhirt, vice president for patient care.

 

"In medical and surgical, I have absolutely zero openings," he said. "In 20 years of doing this, I've never been able to say that."

 

Montgomery General Hospital nursing recruiter Nicholas Piazza said nurses and hospitals need to remember the economy hasn't fixed the nursing shortage.

 

He said the employment situation right now is just "a blip when the (bad) economy masks the true nursing shortage."

 

Federal experts say population growth in the United States means the nursing shortage will grow to 275,000 by 2010. In the following decade, officials expect it to reach 1 million.

 

The American Academy of Colleges of Nursing says a lack of instructors in nursing schools meant that 27,771 applicants were turned away even though they were qualified. Many younger nurses don't become educators because a master's degree or doctorate is required, yet salaries are lower than what acute-care nurses make.

 

Copyright 2009 Daily Record.

 

Catania/Whitman-Walker Melee Gets Bloodier

 

By Tim Craig

Washington Post

Monday, April 27, 2009

 

D.C. Council member David. A. Catania clashed with leaders of the Whitman-Walker Clinic at a hearing today that highlights growing hostility between the clinic and the Council. In a series of exchanges as they argued over who has the best vision for responding to the city's HIV/AIDS epidemic, Catania accused Whitman-Walker of financial irregularities that may have violated federal law. Clinic officials in turn charged Catania with making threats and being abusive to clinic officials out of his desire to destroy the health center.

 

Catania, the openly gay chairman of the Health Committee, said he has evidence that Whitman-Walker collected employees' contributions for their retirement plans last spring but did not send them along to be invested. Catania said he suspects the clinic, which has been struggling financially, was using the money to pay bills.

 

"This was a violation of federal law," said Catania, who blamed mismanagement for a has been a steep decline in its fundraising.

 

Catania has called for Donald Blanchon, the clinic's chief executive officer, to be fired. But the board has rallied behind Blanchon.

 

This morning, Blanchon and June Crenshaw, the chairwoman of the board, said they reacted quickly after learning that employee contributions to their pension plan were not being remitted. They said they ordered the money be transferred with an additional 6 percent in interest.

 

Crenshaw and Blanchon accused Catania of having a "vendetta" against Whitman-Walker because several of his friends were laid off in December. They said Catania's investigation is distracting the clinic from its work in fighting the city's HIV/AIDS epidemic.

 

"You have told members of our board that you will destroy Whitman-Walker if they do not fire me," Blanchon testified. "Mr. Catania, we are in the midst of an HIV epidemic. . . . It is difficult to conceive that the chair of the City Council's Health Committee would threaten the existence of the leading AIDS clinic in the community over a matter he admits is personal."

 

Catania said he's just trying to ensure the clinic, which nearly closed in 2005 because of budget constraints, can continue serving the city's gay community.

 

"'I see a complete lack of aggressive leadership," Catania said.

 

Michael Manganiello, a board member, submitted written testimony in which he accused Catania of verbally assaulting him because the board refused fire Blanchon.

 

"He became very angry, saying 'There is only one thing you can do. There is no room for compromise,' " Manganiello wrote.

 

Manganiello wrote that when he told Catania the board would not fire Blanchon, "Mr. Catania shouted, 'Then lose my number. . . . You have no access to me.' "

 

To help fend off Catania's charges, Whitman-Walker hired Arnold & Porter LLP this spring to conduct an internal audit of the clinic.

 

The firm issued a 300-page report that refuted many of Catania's charges. But Catania sought to debunk the report, saying the former chairman of Whitman-Walker, James Sandman, used to be a partner at Arnold & Porter. Another clinic board member is married to an Arnold & Porter lawyer, Catania noted.

 

During her testimony, Crenshaw accused Catania of once threatening to "burn Arnold & Porter's house down."

 

"You have stated that Arnold & Porter's findings are a whitewash, but you offer no evidence to support that conclusion," she said.

 

Catania did not directly address that allegation of threatening the law firm, but said, "The notion that this Council wants to try to destroy Whitman-Walker is so obnoxious on its face its hard me to say it with a straight face."

 

Copyright 2009 Washington Post.

 

Homeless face growing demand for housing

 

By Mary Gail Hare

Baltimore Sun

Monday, April 27, 2009

 

Kimberly Edmonds moved with her energetic 2-year-old son into a Baltimore County homeless shelter two months ago.

 

"I was upset, and I cried a lot," the 41-year-old former Rosedale resident said. "My son and I should not be in this situation. I would not wish it on my worst enemy."

 

Surrounded by trees and spacious lawns, the two-story brick building housing the Hannah More shelter on Reisterstown Road resembles a college dorm. The 75-bed shelter is clean and well-maintained. A nearby playground with brightly colored slides and swings helps occupy her son, Christian. But this is not home.

 

"I am the face of homelessness," Edmonds said.

 

Blanche Coady, supervisor of information referral for the county's Community Services, said she handles at least 25 requests a day for a bed in a county shelter. She promises help, but has had to tell many they must wait. Edmonds waited two weeks.

 

"This winter the numbers really jumped high," Coady said. "We typically would get about 375 calls a month. Now it's 500 or more." Demand for shelter has tripled in the past 10 years, she said.

 

Baltimore County's identified homeless population grew to about 6,300 in 2008, up 800 from the year before, according to officials. Nearly 70 percent of them were women and children.

 

The problem is "statewide, nationwide, even international," said Jeff Singer, president of Health Care for the Homeless in Baltimore. In the first four months of this year, the number of newly homeless increased across Maryland by 15 percent over the same period last year, he said.

 

"The reasons are complex, ranging from job loss to apartment buildings getting foreclosed without the tenants knowing," he said. "If you lose your job, you can hang on for a while, but eventually you exhaust your resources."

 

Christian was born with several developmental problems that made it impossible for Edmonds to continue working in a secretarial job. She went through her savings and lost their apartment in Rosedale earlier this year. After crowding in with relatives for several weeks, her situation became intolerable, she said, and she started calling Community Services daily seeking help.

 

She and her son are among more than 500 men, women and children living in county shelters. At least a third are younger than 17, and last year nearly 1,400 attended public schools, according to the county.

 

Edmonds, who loves to cook, says she misses her own kitchen. She shares sleeping quarters with another mother and child. Christian easily climbs out of the playpen that is his bed. While the shelter staff is helpful and the other residents are friendly, they are not family.

 

Robert Quigg, who sees most beds filled every night in the three shelters he manages, has heard countless stories of hardship like that of Joseph Gannon, a laid-off truck driver who became homeless a year ago.

 

"It is a terrible, frightening prospect, no matter what the cause," Gannon said. "It strips you of all you have worked for."

 

While in the shelter program, Gannon said he could think clearly and get his life back together. He found a job and an apartment and has recently purchased a car.

 

A critical lack of affordable housing is exacerbating problems for the homeless, Quigg said. A minimum-wage earner can afford $341 in monthly rent in a county, where the average two-bedroom unit rents for $1,013 a month, Quigg said.

 

Edmonds has received a housing choice voucher to help her pay the rent, but has yet to find a landlord willing to accept that payment. "About half the vouchers are returned, because people cannot find a landlord to accept them," Singer said.

 

Edmonds addressed the Baltimore County Council last week as part of a rally for the homeless, and asked lawmakers to support more funding for social services programs.

 

"I thank this county for having someplace for my son and me," she said. "Other than that, we would be living in my car. Thank you for the things you will be doing. Everyone can do something to help someone who is homeless."

 

Copyright 2009 Baltimore Sun.

 

2010 census undercount could cost state federal funding

 

CNHI News Service

Cumberland Times-News

Monday, April 27, 2009

 

WASHINGTON — Maryland could get shortchanged on its share of $3 trillion in federal funding over the next decade if officials can’t prevent undercounting of residents in the 2010 census.

 

The Census Bureau designated parts of Prince George’s, Montgomery and Frederick counties, as well as Baltimore City, as extremely “hard-to-count” areas in the upcoming decennial census. Undercounting Marylanders could have long-term consequences for the state, since census results affect the distribution of federal funds for things like health care, education programs and public transit.

 

“For every individual that is not counted, you’re talking about approximately $1,000 per year in federal funds that the state can garner for either goods or services,” said Marco K. Merrick, director of communications and education for the Maryland Department of Planning. “If we miss an entire family of four, that’s $4,000 in a year, which really equals $40,000 for the census’ 10-year span.”

 

Urban centers and high-poverty areas, immigrant and minority communities are most susceptible to miscounts, Merrick said. Minorities tend to be undercounted because some, especially immigrants, are mistrustful of and avoid sharing information with the government.

 

Maryland had the seventh-highest minority population in the country as of 2007, according to Census Bureau statistics. Blacks were the largest minority group, about 30 percent of the state’s population, while Hispanics and Latinos were the second-largest group, about 6.3 percent.

 

Maryland’s foreclosure crisis could also cause miscounting, because many people have been forced into temporary, hard-to-track housing arrangements. Prince George’s County alone tallied 12,573 foreclosures in 2008. In the fourth quarter of 2008 the state’s concentration of foreclosures-per-household ranked 18th in the nation, according to the Maryland Department of Housing and Community Development.

 

The Census Bureau has established measures to handle unusual housing situations, said Arnold Jackson, associate director for the national census.

 

“We are seeing a surge of tent cities and unusual living arrangements ... However, we have always counted places like RV parks, labor camps and people in shelters. We have special enumeration procedures in place.”

 

It’s not just money on the line, but also government. The 2010 census could affect state political districts because of population changes, said Michael J.G. Cain, director of the Center for the Study of Democracy at St. Mary’s College of Maryland.

 

In the past, Cain said, such changes contributed to political shifts in state elections. He pointed to demographic shifts recorded in the 1990 census that probably affected election outcomes in 1992 and 1994.

 

“Republicans doubled their number of state senators in 1994 to 15, and in the House almost doubled their number of delegates to about 40,” Cain said. “Part of that had to do with the Republican revolution going on at the time, but it was also partly to do with redistricting.”

 

To reach traditionally undercounted populations, the Census Bureau has invested more than $300 million in a major advertising campaign to begin in the fall, including $212 million in stimulus funds. Of that, more than $100 million is directed to media advertising, some nationally, but more than half at the local and regional levels.

 

Campaigns will target African Americans, Latinos, Asians, native Hawaiians, American Indians and Alaska natives, Jackson said. Preparations for the campaign included more than 70 focus group studies.

 

“We’ve done focus groups for Latino households who don’t speak Spanish. We’ve done focus groups for Latino households from Central America,” Jackson said. “We recognize that one size does not fit all, and this is an expensive proposition.”

 

The Census Bureau also enlisted organizations already working in communities to help educate minorities on what the census means for them.

 

Martha Bazurto, director of the Latino Federation of Greater Washington, said 34 of its member agencies will help spread the word, both in everyday operations and at special events.

 

“In the Latino community, we’ve always said we want a bigger piece of the pie,” Bazurto said, “and we can’t get it if they don’t count us right.”

 

Copyright © 1999-2008 cnhi, inc.

 

Suburban, Johns Hopkins to merge health systems

 

Associated Press

Daily Record

Saturday, April 25, 2009

 

Johns Hopkins Health System and Suburban Hospital Healthcare System say they are merging to offer more efficient, integrated medical services in the region.

The systems announced Friday that the proposed merger is expected in the fall and wouldn't involve any financial exchanges.

If the merger happens, Johns Hopkins will completely assume ownership of the Montgomery County-based organization and Suburban Hospital. Both companies say Suburban's name, leadership and daily operations won't change.

Both companies say the change would help them address health care reform, offer health care in a more efficient way and provide better access to patients for health care.

Johns Hopkins said it has no plans to acquire other hospitals.

 

Copyright 2009 Daily Record.

 

National / International

 

Questions And Answers About Swine Flu

 

Washington Post

Monday, April 27, 2009

 

Q: What is swine flu?

A: It is an influenza virus, like the strains that cause such misery to people during the winter months. Flu viruses also infect many other species of mammals, as well as birds, and this strain causes a respiratory disease in pigs. It is related to human viruses, but influenza tends to stay in its own "host" species.

 

How does it pass from pigs to people?

The most common method is through farming, with humans handling infected pigs. The flu can then move on to other people through coughing, sneezing, or touching infected people or surfaces and then touching your mouth or nose.

 

Such infections are rare because swine flu viruses do not easily attach to human cells of the throat and lungs. However, recent studies have shown human infections may be more common than once believed.

 

Can you catch swine flu by eating pork from an infected animal?

The Mexican government and the World Health Organization have ruled out any risk of infection from eating pork.

 

What are the symptoms?

The Mexican government reports seeing these symptoms:

 

-- Sudden fever above 100 degrees Fahrenheit.

 

-- Dry cough and/or sore throat.

 

-- Headache.

 

-- Joint pain.

 

-- Nasal congestion.

 

-- General fatigue.

 

Those sound like seasonal flu symptoms. How is this flu different?

Swine flu may cause more severe vomiting and diarrhea. In rare cases, flu virus attacks the lungs, a complication that can be fatal. This strain also differs because it is so new. As a result, no one has natural immunity to it, unlike with seasonal flu.

 

The numbers of infected people are rising quickly. Is this a very infectious disease?

The CDC says it does not yet know. Occasionally a swine flu virus in a person mutates in a way that makes it more easily transmitted from person to person.

 

People are usually contagious for as long as they are symptomatic -- typically four to five days for adults and longer for children.

 

I got a flu shot last fall. Will that protect me?

CDC officials say they are "very pessimistic." Tests of last fall's seasonal vaccine and the new virus show no cross-reaction, suggesting that people who got the shot have no added protection against this flu strain.

 

How should I protect myself and my family?

If you have no symptoms, be preventive: Wash your hands often with soap and water. Cover your mouth and nose when you cough and sneeze, and discard used tissues immediately. Avoid close contact with people who are sick.

 

If you feel sick, stay home from work and school. Go to the hospital if you experience severe symptoms, such as difficulty breathing.

 

If you know you have been exposed to swine flu, get lots of rest, and talk to your doctor about the antiviral drugs oseltamivir (trade name Tamiflu) or zanamivir (Relenza). These drugs may make the illness milder and work best if started within two days of getting sick.

 

I see people in Mexico wearing masks. Should I get one?

Mexico's government is recommending surgical masks for its citizens, but the CDC says the general U.S. public does not need them.

 

What is the difference between an epidemic and a pandemic?

An epidemic is an outbreak of a disease in a community or region. A pandemic is an epidemic that spreads on a global scale. Epidemics and pandemics may involve a new disease or a new form of an old disease. In the case of a pandemic, few people have immunity to the disease, and it can spread easily between people. Officials are calling the current outbreak an epidemic. Find more information on disease outbreaks.

 

What are the WHO pandemic phases?

The World Health Organization uses a six-phase scale to help inform the public on the seriousness of a threat and guide pandemic preparedness and response plans. The first three phases involve preparedness, while the last three signal a need for response. For more information about each phase, visit WHO's site on pandemic alerts.

 

This report includes information from staff writer David Brown, the Associated Press, Reuters, the Los Angeles Times, the U.S. Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, and the World Health Organization

 

Copyright 2009 Washington Post.

 

Q&A: What you should know about swine flu

 

By Stephanie Desmon

Baltimore Sun

Monday, April 27, 2009

 

Don't panic over the swine flu, government officials are urging, but they want people to be cautious, especially those who have recently traveled to Mexico or who are in contact with someone who has.

 

Here are some things you should know, according to the Centers for Disease Control and Prevention:

 

How can I protect myself?

Wash your hands often with soap and water, especially after you cough or sneeze. Avoid touching your eyes, nose or mouth. Avoid sick people and if you are sick, stay home.

 

What if I get sick?

Two antiviral drugs - marketed as Tamiflu and Relenza - appear to be effective against this strain of the swine flu. If you get sick, the drugs can make the illness milder, make you feel better faster and may prevent serious complications. For treatment, antiviral drugs work best if started as soon after getting sick as possible, and might not work if started more than 48 hours after illness starts.

 

How dangerous is it?

Experts don't know how deadly swine flu is because they don't know how many people have been infected. The World Health Organization says the overall mortality rate is 1 to 4 percent.

 

Should I avoid travel to Mexico?

The CDC has yet to recommend against traveling to Mexico, but the European Union's health commissioner is advising against any non-urgent travel to the United States or Mexico.

 

Why are people dying in Mexico and not here?

That's a huge mystery. First, understand that no one really knows just how many people in Mexico are dying of this flu strain, or how many have it. Only a fraction of the suspected deaths have been tested and confirmed as swine flu, and some initially suspected cases were caused by something else.

 

What are the symptoms?

They're similar to regular human flu - a fever, cough, sore throat, body aches, headache, chills and fatigue. Some people also have diarrhea and vomiting.

 

How do I know if I should see a doctor?

Health authorities say if you live in places where swine flu cases have been confirmed, or you recently traveled to Mexico, and you have those symptoms, your doctor can decide whether you need treatment or to be tested.

 

Did last winter's flu shot protect me?

Probably not. Even though it did protect against the Type A family of flu viruses that this new swine flu belongs to, the Centers for Disease Control and Prevention ran some preliminary tests and doesn't think it offered any cross protection.

 

Why are people calling it swine flu if it's not just from pigs? Did it really come from pigs?

Pigs do spread their own strains of influenza and every so often people catch one, usually after contact with the animals. This new virus is a mix of human, pig and bird viruses but the name, for ease, was shortened to swine flu - and unlike typical swine flu, it is spreading person-to-person.

 

So is it safe to eat pork?

Yes. Swine influenza viruses don't spread through food.

 

The Associated Press contributed to this report.

 

U.S. health emergency declared over swine flu

Confirmed American cases at 20, but no fatalities seen

 

Tribune Newspapers

By Jim Tankersley and Thomas H. Maugh II

Baltimore Sun

Monday, April 27, 2009

 

U.S. officials declared a public health emergency Sunday as eight cases of swine flu were identified in New York and one was announced Ohio, bringing the total of confirmed U.S. cases to 20.

 

In a briefing at the White House, the acting head of the Centers for Disease Control and Prevention, Dr. Richard Besser, warned Americans to prepare for a widespread outbreak, yet urged the public to remain calm.

 

Also Sunday, Homeland Security Secretary Janet Napolitano said the government would release a quarter of its 50 million-unit strategic reserve of antiviral medications, which combat the disease in infected patients, to states where outbreaks had occurred.

 

Canadian officials, meanwhile, said that four cases had been confirmed in Nova Scotia and two in British Columbia, marking the first time that this particular strain had appeared north of the U.S. border. All six Canadian cases were mild, like those in the United States.

 

Several other countries have reported influenza-like illnesses that they suspect might be swine flu in travelers returning from Mexico, but as of Sunday evening, none of them had been confirmed.

 

Nonetheless, many nations moved quickly to limit the disease's spread, in many cases appearing to be near panic. Some, such as Poland and Venezuela, warned against traveling to the United States or Mexico. Others, such as Russia and Brazil, began screening incoming international air travelers for signs of high fever.

 

China, Russia and Taiwan said they would quarantine returning passengers with flu symptoms.

 

In Mexico, Health Secretary Jose Angel Cordova said five more deaths had occurred from influenza in that country overnight, bringing the death total to 103. Two of the new cases were confirmed as swine flu, for a total of 22 confirmed swine flu deaths. It was not clear how many of the others were caused by the virus.

 

The number of suspected swine flu cases in Mexico, meanwhile, rose to more than 1,600.

 

Swine flu is "serious enough to be a great concern to this White House and to this government," White House press secretary Robert Gibbs said on NBC's Meet the Press, adding that President Barack Obama is receiving frequent updates on the situation.

 

"We are taking the proper precautions to address anything that happens," Gibbs said. "It's not a time to panic." Napolitano said the emergency declaration was a routine move to ensure that the government was prepared "in an environment where we really don't know, ultimately, what the size or seriousness of this outbreak is going to be." It seemed certain, however, that the number of swine flu cases - mild or otherwise - would rise. "As we continue to look for cases, we are going to see a broader spectrum of disease," Besser said. "We're going to see more severe disease in this country."

 

Because of the situation in Mexico, "I do feel that we will have deaths here," Dr. Anne Schuchat of the CDC said at a separate news conference.

 

Besser said that the CDC had isolated the swine flu virus and prepared a "seed stock" for the manufacture of a vaccine but will not distribute it to pharmaceutical companies until the situation becomes more severe. Manufacture of a new vaccine would take months.

 

Public health officials cast the various moves as aggressive but precautionary, and they counseled calm.

 

The eight confirmed cases in New York involved students at St. Francis Preparatory School in Queens. City officials had said Saturday that the virus involved was probably swine flu; the assumption was confirmed by researchers at the CDC.

 

Some of those students had taken a spring break trip in Mexico. Flu-like symptoms have been reported in some of the parents, but causes have not been confirmed. Officials also tested children at a New York day care center where illness had been reported, but those tests came back negative.

 

The new case in Ohio is a 9-year-old boy in Lorain County. He has a mild case of the disease and is recovering at home.

 

Previously announced cases included two in Texas, two in Kansas and seven in California's Imperial and San Diego counties. All the cases were mild, and the victims have recovered.

 

The Nova Scotia Department of Health Promotion and Protection said Sunday that four cases had been confirmed in Windsor, in eastern Canada. The victims were students who had recently traveled to Mexico. None of them have been hospitalized.

 

Two teenage boys in British Columbia in western Canada were also confirmed to have swine flu. Both had mild cases.

 

Copyright 2009 Baltimore Sun.

 

Dept. of Homeland Security Secretary Janet Napolitano Holds Press Conference on Swine Flu

 

CQ Transcripts Wire

Monday, April 27, 2009

 

SPEAKER: SECRETARY OF HOMELAND SECURITY JANET NAPOLITANO

 

[*] STAFF: Good afternoon. Thanks for -- for being here.

 

In a minute, Secretary Napolitano is going to make some remarks and then open it up for questions. She is joined with her today by the undersecretary of state for management, Pat Kennedy, and the president's counterterrorism and homeland security adviser, Mr. John Brennan.

 

NAPOLITANO: Thank you. Good afternoon.

 

This is the second daily briefing, and we will do these on a regular basis as we work our way through these -- the swine flu issue, what is happening at the governmental level, and what is happening around the world.

 

First, I would like to inform you that today both the CDC and the State Department will be issuing travel alerts related to swine flu and related to travel to Mexico. What those alerts mean is that they encourage individuals to avoid any non-essential travel to Mexico for the time being.

 

You may ask, how long will the alerts be operative? And the answer is, we don't know, because, obviously, it's related to how much swine flu is being detected.

 

But those alerts are in the process -- I think CDC has already posted theirs, and the State Department is in the process of posting those travel alerts.

 

Secondly, as President Obama said this morning, swine flu is a cause for concern, but not a cause for alarm. We are simply in preparation mode. We do not yet know how widespread this flu will be within the United States. So we continue to move aggressively to prepare.

 

I spoke this afternoon with Mexico's ambassador to the United States so that our governments are moving in tandem, and I will be speaking later on with my counterpart in Canada. We really have a tri-national approach to the flu issues.

 

As I said yesterday, I issued a public health emergency declaration. That permitted today the -- an emergency authorization that allows the FDA to proceed to permit things like Tamiflu to be used for populations that they otherwise wouldn't be used for, in this case, for example, very, very young children.

 

The Department of Homeland Security is conducting conference calls with state public health and homeland security officials on a daily basis to discuss developments related to swine flu. And I've reached out to the governors of each of the states where a confirmed case has -- has arisen.

 

As I said yesterday, we're in the process of activating our national stockpile of antiviral drugs. The priority is placed on states that have been affected, as well as states along the border, and antivirals already are on the way to some of these states.

 

All states will have access to the national stockpile, and full deployment is expected by the 3rd of May. The Department of Health -- the Department of Homeland Security -- excuse me -- continues to direct people entering the United States from Mexico who appear to be sick to the CDC or to local health officials to be evaluated.

 

In addition, the traveler's health alert notices are being posted at ticket counters and gates within the airports. And at the land ports, there's a tear sheet that is being handed out to travelers.

 

We are reaching out to the private sector to make sure that they are preparing and to inform them of the latest actions we are taking. It's important that they be thinking ahead about what they would do should this erupt into a full-fledged pandemic, which it has not yet, by the way.

 

And, finally, we are taking precautionary measures with respect to the health of our own workforce. We have prepositioned antivirals for all the nine Border Patrol sectors and for our Coast Guard sectors to assure they remain at full strength. We've provided guidance to all employees on how to use antivirals.

 

We continue to stress, the CDC continues to stress, the Department of Health and Human Services continues to stress that common sense will go a long way here to mitigate the impact of any flu. Common sense means washing hands, staying home from work or school if you feel sick, covering your mouth if you cough or sneeze. These are straightforward and simple measures, but they can materially improve our chances of avoiding a full-fledged pandemic.

 

Everybody has a role to play here. It's our function to make sure that what the government is doing is coordinated, that we are thinking in advance of the problem.

 

But, again, government cannot do this alone. We all have an important part to play.

 

NAPOLITANO: So, with that, alerts are posted. Information is available, by the way, for people who are interested. The CDC Web site is a very, very good Web site; cdc.gov/swineflu is the exact address.

 

In addition, www.state.gov and travel.state.gov, the two State Department Web sites, also have information. Of course, the Department of Homeland Security's Web site has information and will click you over into other department Web sites, as well.

 

With that, John, Pat, I'll be happy to take some questions.

 

QUESTION: Can you give us any information about how many people are coming into the U.S. either on land or -- or (OFF-MIKE) have been referred to (OFF-MIKE) authorities?

 

NAPOLITANO: Don't know yet. We're -- we're just in the beginning process of trying to collect that kind of information. But, again, what I've -- what I've been saying is, we'll provide you with information on a daily basis as we work our way through this.

 

QUESTION: How does that work? Someone comes to the border inspection person and is coughing or displays some sort of symptom, is there a health professional right there to see them? And who are those folks?

 

NAPOLITANO: It depends on which port you're entering at, you know, because there are different sizes, different locales, and all the rest.

 

Generally speaking, they're referred to or put in another room. I don't want to use the word "quarantine," because technically it's not a quarantine, but they're put in a separate room. And they are either questioned by a Customs and Border Protection officer who has some training in this or, in the bigger ports, either a public health official who is on site or they call the local public health authority to have some people brought over.

 

And they'll question them. And then, if it's ascertained that they may, indeed, have the flu, they'll make a decision about whether they can go ahead and enter the country and go to a place to get taken care of or whether they need to go back home.

 

QUESTION: But it doesn't appear to be that -- that just large numbers of people are being diverted to this secondary inspection? NAPOLITANO: Not that I've heard of today. And, again, this is a changing scene, and so that may change. But, as of today, I have not heard of that.

 

QUESTION: How has Mexico done in responding to this?

 

NAPOLITANO: Well, Mexico's had -- had a much more acute problem to solve. And you know the steps that have been taken in Mexico City, for example, with respect to closing down the schools, shutting off places where people would gather, issuing masks, and the like. So they are taking every public health precaution one can identify with respect to this kind of an outbreak.

 

We have people down there now, teams from the CDC. One of the things that we are assisting on is laboratory capacity for running diagnostic samples, but also, collecting good data, because it will help us for our planning if we can see how widespread this really is in Mexico.

 

QUESTION: Can you tell us, Madam Secretary -- and perhaps Mr. Brennan, as well -- a little bit about when the United States government first became sort of fully aware of, you know, these events in Mexico and how you began to come up with your response for them? And then what about today brought on the travel alert? What changed today to bring on the travel alert?

 

NAPOLITANO: Sure.

 

John, do you want to -- OK.

 

BRENNAN: The first instances of the influenza down in -- in Mexico were the end of last week. In terms of confirmation, it was like Thursday or Friday of last week.

 

So the Mexican health authorities knew they had a health issue. And, therefore, they sent the samples to both the Canadian labs, as well as to the CDC. And so the confirmation that it was swine flu was last week.

 

But to date, at least from my perspective, the Mexican authorities have been exceptionally cooperative and forthcoming. Both Secretary Napolitano and I have spoken to the Mexican ambassador. I think there's been very strong cooperation.

 

NAPOLITANO: Yes. And, by Friday, we were beginning to assemble the -- the information and form the interagency team that would need to work this issue over the weekend. And under HSPD-5, you know, I was designated as the principal federal official and we began. That whole process was well underway as we worked throughout the weekend.

 

QUESTION: (OFF-MIKE) and it was Mexican authorities who first notified the United States (OFF-MIKE)

 

BRENNAN: It was through the health -- through the health...

 

NAPOLITANO: There were health issues. BRENNAN: Professionals that were cooperating, both U.S. and Mexican health officials.

 

QUESTION: (OFF-MIKE) State Department question about why today and the travel alert?

 

NAPOLITANO: I think that, in part, is just because the data -- as the data becomes more robust, then better decisions can be made about what actually needs to happen.

 

QUESTION: What kind of guidance are you giving state and local governments, in terms of what they should do if they have cases of -- of the flu now? For instance, are you suggesting, if it's in a school, they close down the schools?

 

NAPOLITANO: The CDC has issued community mitigation guidance to communities. And we can give you an actual copy of that.

 

QUESTION: Sorry. Have you issued any (OFF-MIKE) law enforcement (OFF-MIKE)

 

NAPOLITANO: We are in touch with local law enforcement, and we're in touch with the fusion centers in -- in the various states. And they have access to all the material, for example, that's posted on the CDC Web site, our Web site, and the like, for whatever use they care to make.

 

QUESTION: Will the administration be making any kind of additional budget requests to Congress to cover actions taken, actions that may be taken, or (OFF-MIKE)

 

NAPOLITANO: I don't think any decisions have been made on that yet.

 

QUESTION: Can you talk about the lack of personnel across both HHS and DHS and (OFF-MIKE) for pandemics (OFF-MIKE)

 

NAPOLITANO: Yes. With respect to presidential-appointed confirmees, those roles are all being filled by career civil servants who have a great deal of experience. And, as far as I'm concerned, the process, the work has been moving very smoothly and with great -- great efficiency. So I think we're moving right along in that sense.

 

With respect to the pandemic playbook, you know, the World Health Organization has us at level three, which is basically preparatory to pandemic. Today, they are meeting with respect to whether that level should be raised. Level six is actual pandemic.

 

And so we're -- we're keying off of that. And even if they raised the level today, our preparations now are as if it had already been raised. So we are proceeding as if we are preparatory to a full pandemic.

 

We don't know that a pandemic actually will occur, but because we want to make sure that we have equipment where it needs to be, people where they need to be, and, most important, information shared at all levels, we've already organized as if -- as if this were.

 

QUESTION: I think, at the next level, at level four, that there are possible (OFF-MIKE) parts of the border could be closed or increased border surveillance of people coming across. Is that something that's been discussed at this point?

 

NAPOLITANO: Well, as I said yesterday, we're already doing passive surveillance at the border. And with respect to closing the border, again, you would close the border if you thought you could contain disease, the spread of disease, but the disease already is in a number of states within the United States, so the containment issue doesn't really play out.

 

And this particular flu, you can -- you can actually have it for a couple of days before you show any symptoms. And so even if you -- I mean, people could be coming through now even under passive surveillance who actually have the flu. So it's -- that's a very difficult judgment to make.

 

QUESTION: Other than notices being posted at gates at the airport, specifically what else is (OFF-MIKE) doing? Are passengers being questioned (OFF-MIKE)

 

NAPOLITANO: Well, again, if -- if they're coming from international travel, they have to go through CBP. And CBP is doing the passive surveillance, if passengers appear sick, and they are also asking or able to ask questions, particularly on -- on flights that originate in Mexico.

 

And we're giving, on the land ports -- as I said before, they're giving out what's called a tear sheet, which is -- and we can give you a copy of that. It tells you what to look for and what to do if you think you're getting ill. And that information is being posted in the airports and at the gates.

 

QUESTION: Are there any quarantines (OFF-MIKE)

 

NAPOLITANO: My understanding is that we have 19 airports that have quarantine available. That would cover about 85 percent of air travelers. But we haven't activated that need yet, and we may -- we may not need to. We don't know. But we have identified where they are, what we would need to do in case the facts warrant it later on.

 

STAFF: Last question.

 

QUESTION: You say that it takes about three to four days for the symptoms to show up. So people could come in by air, not know that they have it because symptoms haven't shown up, and they'll be able to walk right in, right? I mean, is there any -- any contingency plans for dealing with that? How -- you know, how would you -- how would you deal with -- with something like that?

 

NAPOLITANO: Well, if people are sick and if you have the flu, you believe you have the flu, you have a fever, you have a heavy cough, we're asking people...

 

QUESTION: (OFF-MIKE)

 

NAPOLITANO: I'm asking people -- we're asking people: Don't go to school. Don't go to work. Don't go to a place where you can infect other people.

 

I mean, the normal tendency is, you know, we have a lot of Type A personalities and people want to go, keep working, and -- and -- and we're saying don't do that if you believe realistically that you have the flu. If you don't know but you show some of the symptoms, contact your doctor.

 

And -- and going to, I think, your question, what you're saying is, people could still be coming in the country because they're asymptomatic, may have the flu, and that is true. But, again, given the number of cases and what's actually appearing and the like, we believe, at this level, the appropriate precautions have been taken.

 

Thank you all.

 

STAFF: Thanks, guys.

 

QUESTION: Thank you.

 

QUESTION: (OFF-MIKE)

 

NAPOLITANO: I didn't get to go.

 

QUESTION: (OFF-MIKE)

 

NAPOLITANO: The deputy secretary went in my place.

 

QUESTION: (OFF-MIKE) very young children?

 

NAPOLITANO: Pardon me?

 

QUESTION: Why didn't (OFF-MIKE) authorization for very, very young children (OFF-MIKE)

 

NAPOLITANO: Well, Tamiflu normally is not prescribed for children under the age of four.

 

QUESTION: Well, why (OFF-MIKE) given to authorize that (OFF- MIKE)

 

NAPOLITANO: That question you should address to the CDC.

 

STAFF: Thank you, everyone.

 

END

 

Copyright 2009 Washington Post.

 

Swine flu prompts EU warning on travel to US

 

By Daniel Woolls

Washington Post

Monday, April 27, 2009

 

MADRID -- The top EU health official urged Europeans on Monday to postpone nonessential travel to parts of the United States and Mexico because of the swine flu virus, and Spanish health officials confirmed the first case outside North America.

 

Russia, Hong Kong and Taiwan said they would quarantine visitors showing symptoms of the virus amid a surging global concern about a possible pandemic.

 

World stock markets fell as investors worried that the deadly outbreak could go global and derail any global economic recovery. Airlines took the brunt of the selling.

 

The virus was suspected in up to 103 deaths in Mexico, the epicenter of the outbreak with more than 1,600 cases suspected, while 40 cases _ none fatal _ were confirmed in the United States and six in Canada, the World Health Organization said.

 

"Today we've seen increased number of confirmed cases in several countries," WHO spokesman Paul Garwood told The Associated Press. "WHO is very concerned about the number of cases that are appearing, and the fact that more and more cases are appearing in different countries."

 

President Barack Obama said the threat of spreading infections is cause for concern but "not a cause for alarm."

 

The WHO set its pandemic alert level at level 3, which means there is an animal virus that occasionally causes human cases but that doesn't spread well between people. If the WHO raises it to 4 or 5, that signals that the swine flu virus is becoming increasingly adept at spreading between humans. That move could lead governments to set trade, travel and other restrictions aimed at limiting the disease's spread.

 

In Luxembourg, European Union Health Commissioner Androulla Vassiliou urged Europeans to postpone nonessential travel to parts of the United States and Mexico affected by swine flu, toning down earlier comments referring to all of North America.

 

"I meant a travel advisory, not a travel ban, for travel to Mexico City and those states in the United States where we have outbreaks" of swine flu, he said.

 

The EU health commissioner only makes recommendations to the 27 member countries; they must make a final decision to set travel advisories through their foreign ministries.

 

Dr. Richard Besser, acting head of the Centers for Disease Control and Prevention in Atlanta, said the EU recommendation was not warranted. "At this point I would not put a travel restriction or recommendation against coming to the United States."

 

A top German holiday tour operator said it was suspending charter flights to Mexico City.

 

"These are early days. It's quite clear that there is a potential for this virus to become a pandemic and threaten globally," WHO spokesman Peter Cordingley told AP Television News.

 

Spain's first swine flu case _ confirmed by the WHO _ was a young man in the town of Almansa who recently returned from Mexico for university studies and is responding well to treatment, said Health Minister Trinidad Jimenez. Neither the young man nor any of the 20 other people under observation for the virus were in serious condition.

 

Three New Zealanders recently home from Mexico were suspected of having swine flu. Israel has put two people under observation, while France and Brazil have also reported suspected cases.

 

Cordingley singled out air travel as an easy way the virus could spread, noting that the WHO estimates that up to 500,000 people are on planes at any time.

 

Governments in Asia _ with potent memories of SARS and avian flu outbreaks _ heeded the warning amid global fears of a pandemic.

 

Singapore, Thailand, Japan, Indonesia, and the Philippines dusted off thermal scanners used during the 2003 SARS crisis and were checking for signs of fever among passengers arriving from North America. South Korea and Indonesia introduced similar screening.

 

In Malaysia, health workers in face masks took the temperatures of passengers as they arrived on a flight from Los Angeles.

 

Russia, Hong Kong and Taiwan said visitors returning from flu-affected areas with fevers would be quarantined.

 

Australian Health Minister Nicola Roxon said pilots on international flights would be required to file a report noting any flu-like symptoms among passengers before being allowed to land in Australia.

 

China said anyone experiencing flu-like symptoms within two weeks of arrival had to report to authorities.

 

India will start screening people arriving from Mexico, the United States, Canada, New Zealand, Spain, Britain and France for flu-like symptoms, said Vineet Chawdhry, a top Health Ministry official. It also will contact people who have arrived from Mexico and other affected countries in the past 10 days to check for the symptoms, he said.

 

Some officials cautioned that the checks might not be enough.

 

The virus could move between people before any symptoms show up, said John Simon, a scientific adviser to Hong Kong's Center for Health Protection.

 

Thomas Tsang, controller for Hong Kong's Center for Health Protection, said the government and universities aim to develop a test for the new flu strain in a week or two that will return results in four to six hours, compared with existing tests that can take 2-3 days.

 

China and Russia banned imports of pork and pork products from Mexico and three U.S. states that have reported cases of swine flu, and other governments were increasing their screening of pork imports.

 

Indonesia, which was hit hardest by bird flu, said it was banning all pork imports.

 

Lebanon's agriculture ministry also banned all imports of pork and pork products, excluding some canned products. It also says it will destroy any pork shipments to have entered Lebanon from a country declared infected with the swine flu virus by the WHO or countries with suspected cases.

 

The CDC says people cannot get the flu by eating pork or pork products.

 

Germany's largest tour operator, the Hannover-based TUI, suspended all charter flights to Mexico City through May 4. The suspension includes flights operated by TUI itself and also through companies 1-2 Fly, Airtours, Berge & Meer, Grebeco and L'tur.

 

TUI said other holiday trips to Mexico would continue to operate but would not make stops in Mexico City "for the next few weeks." Japan's largest tour agency, JTB Corp., suspended tours to Mexico at least through June 30.

 

Russian travel agencies said 30 percent of those planning to travel to Mexico in early May had already canceled.

 

At Madrid's Barajas International Airport, passengers arriving from Mexico were asked to declare where they had been in Mexico and whether they had felt any cold symptoms. They were told to leave a contact address and phone number.

 

"Where we were, there was no real alarm but we followed what was happening on the news and we're a little bit worried," said Spaniard Filomeno Ruiz, back from vacation in Cancun.

 

Passengers were also urged to contact health authorities if they notice any symptoms in the 10 days following arrival.

 

In the airport's baggage claim area, ground crews and police wore surgical face masks. Some travelers took precautions even though they had not been in Mexico.

 

"Nobody has recommended it, but I've put the mask on out of precaution," said Roger Holmes of Britain, who was traveling to Tunisia from Madrid. "I'm not afraid, but it costs nothing to be careful."

 

New Zealand Health Minister Tony Ryall said two students and a parent among a group of 15 who just came back from a class trip to Mexico had mild flu and were being tested for swine flu. On Sunday, officials said nine students and one teacher from a separate group that also were in Mexico "likely" have swine flu.

 

All the New Zealand students and teachers along with their families had voluntarily quarantined themselves at home. Ryall said three small groups of returned travelers were being monitored after reporting flu symptoms following recent trips to North America. He gave no other details.

 

On the Net:

WHO swine flu page:http://www.who.int/csr/disease/swineflu/en/index.html

 

CDC:http://www.cdc.gov

 

© 2009 The Associated Press.

 

Swine flu cases in US; agents checking borders

 

By Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; Maria Cheng in London and Eileen Sullivan in Washington contributed to this report

Associated Press

Monday, April 27, 2009

 

WASHINGTON - President Barack Obama declared Monday that spreading swine flu infections were a concern but "not a cause for alarm," while customs agents began checking people coming into the United States by land and air. The World Health Organization said there were 40 confirmed cases in the U.S. but no deaths.

 

Countries across the globe increased their vigilance amid increasing worries about a worldwide pandemic. Obama told a gathering of scientists that his administration's Department of Health and Human Services "has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively."

 

The acting head of the Centers for Disease Control and Prevention, Dr. Richard Besser, said that Americans should be prepared for the problem to become more severe, and that it could involve "possibly deaths."

 

The quickening pace of developments in the United States in response to some 1,600 swine flu infections in neighboring Mexico - and reports that Mexico's suspected swine flu death toll had climbed to 149 - was accompanied by a host of varying responses around the world. Mexico suspended schools nationwide. The European Union advised against nonessential travel to the U.S. and Mexico, while China, Taiwan and Russia considered quarantines and several Asian countries scrutinized visitors arriving at their airports.

 

U.S. customs officials began checking people entering U.S. territory. Officers at airports, seaports and border crossings were watching for signs of illness, said Customs and Border Protection spokesman Lloyd Easterling.

 

The borders are open," Easterling added. He said officials were "just taking a second look at folks who may be displaying a symptom of illness."

 

If a traveler says something about not feeling well, the person will be questioned about symptoms and, if necessary, referred to a CDC official for additional screening, Easterling said. The customs officials were wearing personal protective gear, such as gloves and masks, he said.

 

The CDC can send someone to the hospital if they suspect a case, but no one is being refused entry. Also, the CDC is readying "yellow cards" with disease information for travelers, in case they later experience symptoms.The border monitoring resembles that done during the SARS epidemic earlier in the decade.

 

Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, said they were waiving usual penalties for changing reservations for anyone traveling to, from, or through Mexico, but had not canceled flights.

 

The CDC's Besser said that while the U.S. hasn't advised against travel to Mexico, it has urged people to take precautions, such as frequent hand-washing while there.

 

He also said he did not believe that the EU's inclusion of the U.S. in its travel warnings was warranted "at this point."

 

A private school in South Carolina was closed Monday because of fears that young people who recently returned from Mexico might have been infected.

 

"We are closely monitoring the emerging cases of swine flu in the United States," Obama said. "I'm getting regular updates on the situation from the responsible agencies, and the Department of Health and Human Services as well as the Centers for Disease Control will be offering regular updates to the American people so that they know what steps are being taken and what steps they may need to take."

 

"This is obviously a cause for concern and requires a heightened state of alert, but it's not a cause for alarm," he said.

 

World stock markets fell as investors worried that the outbreak could derail economic recovery. Wall Street, too, dipped in morning trading but stocks regained their footing and posted modest gains by midday.

 

The U.S. declared a national health emergency in the midst of uncertainty about whether the mounting sick count meant new infections were increasing or health officials had simply missed something that had been simmering for weeks or months. The declaration allowed Washington to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they are needed.

 

Besser said he was not reassured by the fact that so far in the U.S., no one had died from the disease.

 

"From what we understand in Mexico, I think people need to be ready for the idea that we could see more severe cases in this country and possibly deaths," he said. "That's something people have to be ready for and we're looking for that. So far, thankfully, we haven't seen that. But we're very concerned and that's why we're taking very aggressive measures."

 

Meanwhile, officials of Newberry Academy in South Carolina said Monday that seniors from the school were in Mexico earlier this month and some had flu-like symptoms when they returned.

 

State Department of Health and Environmental Control spokesman Jim Beasley said test results on the students could come back as early as Monday afternoon. The agency has stepped up efforts to investigate all flu cases in South Carolina. There have been no confirmed swine flu cases in the state.

 

A New York City school where eight cases were confirmed will be closed Monday and Tuesday. Of the 40 reported cases in the U.S., 28 are in New York. Also, 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.

 

In Mexico, the outbreak's center, soldiers handed out 6 million face masks to help stop the spread of the virus that is suspected in up to 103 deaths. Most other countries are reporting only mild cases so far, with most of the sick already recovering.

 

Spain reported its first confirmed swine flu case on Monday and said another 17 people were suspected of having the disease. The European Union health commissioner advised Europeans to avoid nonessential travel to Mexico and the United States. Also, three New Zealanders recently returned from Mexico are suspected of having it.

 

"It was acquired in Mexico, brought home and spread," Nova Scotia's chief public health officer, Dr. Robert Strang, said of Canada's first confirmed cases.

 

Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; Maria Cheng in London and Eileen Sullivan in Washington contributed to this report.

 

Copyright 2009 Associated Press.

 

A.D.H.D. Drugs Linked to Higher Test Scores

 

By Tara Parker Pope

New York Times

Monday, April 27, 2009

 

Children with attention deficit problems make bigger academic gains if they are taking stimulant medications compared to similar kids who aren’t receiving drug therapy, a new study shows.

 

The findings, from a five year study of nearly 600 schoolchildren from across the country, are believed to be the first to offer an objective measure of the effect of drug therapy on a child’s long-term academic achievement. Earlier studies have shown that children who receive medication for attention-deficit hyperactivity disorder behave better in class and can complete more homework. But it hasn’t been clear whether treating A.D.H.D. results in any measurable improvement in long-term academic gains.

 

The latest study, conducted by researchers at the University of California, Berkeley, and published in Pediatrics, tracked standardized math and reading scores among a nationally-representative sample of 600 children from kindergarten through the fifth grade, all of whom had been diagnosed with A.D.H.D. The researchers compared the scores of the students who were on A.D.H.D. medications with similarly diagnosed students who weren’t receiving drug therapy. In the study, taking A.D.H.D. medication was associated with gains in math scores that equated to about a fifth of a school year in extra learning. In reading, the gains were even greater, equating to progress of about a third of a school year.

 

“I think the findings are important because this is the first time that we’ve had objective educational performance measures, to look at whether kids who are taking medications for A.D.H.D. compared to kids who are not, that actually show that they are doing better,” said Richard Scheffler, distinguished professor of health economics and public policy at the University of California, Berkeley’s School of Public Health. “There are 4.4 million A.D.H.D. kids, so this is a huge improvement quantitatively in their school year.”

 

While the study is not a randomized trial measuring the effect of drug treatment versus a placebo, the researchers said the association between medication and academic gains is strong. The study controlled for numerous variables, such as parent’s educational level and other changes that could have influenced test scores. However, A.D.H.D. medication could be a proxy for some other factor influencing a child’s academic performance. For instance, it may be that children whose parents seek out drug therapy for A.D.H.D. are more accepting of the condition and more involved in helping the child achieve at school.

 

The researchers also noted that medication may not be an option for some children who experience side effects like loss of appetite or sleep problems. A broad approach that includes doctors, parents and school officials is needed to help kids with A.D.H.D. close the educational gap, they said.

 

“Medications may not be right for every kid,” Dr. Scheffler said. “But you need to treat A.D.H.D. as a team sport that includes heavy parent involvement, particularly at young ages, and school involvement with individual tutoring and organizational help.”

 

Copyright 2009 New York Times.

 

Doctors urge baseline test for prostate cancer

 

Associated Press

By Marilynn Marchione

Baltimore Sun

Monday, April 27, 2009

 

An influential doctors group is backing off its call for annual tests after age 50 to screen for prostate cancer.

 

"Many men do not need yearly screening," but each man's risk should be individually assessed, said Dr. Peter Carroll, who led the panel that wrote the American Urological Association's new guidelines. They are being issued Monday at the group's annual meeting in Chicago.

 

The new stance brings the group more in line with advice from other experts, who say annual screening is leading to unnecessary biopsies and treatment with little proof that it saves lives. Screening involves a physical exam and a blood test for a substance called PSA.

 

The urology group's new advice says men should be offered a baseline PSA test at age 40, and follow-ups at intervals based on each man's situation. A high PSA at age 40 greatly predicts a risk of prostate cancer, said Carroll, a urologist at the University of California at San Francisco.

 

Doing a baseline test "makes a lot of sense to me," said Dr. Eric Klein, prostate cancer chief at the Cleveland Clinic.

 

Others disagreed. There is no proof that a baseline test will save lives, said Dr. Barnett Kramer, a National Institutes of Health scientist.

 

"The same issue of harm comes up -- overdiagnosis. A baseline PSA, just like regular PSA screening, can lead to the diagnosis of cancers that would not have harmed a man had they not been detected," Kramer said.

 

Prostate cancer is the most common non-skin cancer in American men. An estimated 186,000 new cases and 28,660 deaths from it occurred last year.

 

Cases rose in the late 1980s with the start of testing for prostate-specific antigen, or PSA, a substance the prostate produces when it is inflamed. Despite its name, PSA isn't very specific. It can rise for many reasons besides cancer, such as normal prostate enlargement as men age, use of certain medicines -- even things like a hard bike ride or recent sex.

 

Two big studies last month concluded that annual PSA tests do little to prevent deaths from prostate cancer. But many doctors believe the test may still have value -- if researchers can figure out better ways to use it.

 

New studies at the urology meeting suggest ways. One found that a man's PSA at age 60 can strongly predict whether he ultimately will die of the disease.

 

Dr. Hans Lilja of Memorial Sloan-Kettering Cancer Center in New York tested stored blood samples from nearly 1,200 Swedish men from the early 1980s and checked cancer registries to see how many later developed or died of prostate cancer.

 

If PSA was 1 or less at age 60, the risk of dying of prostate cancer by age 85 was very low -- less than 1 percent -- even if men had the disease for many years. About 90 percent of cancer deaths occurred in men whose PSAs at age 60 were in the top one-fourth of the group.

 

In a different study, Dr. E. David Crawford of the University of Colorado Health Sciences Center studied 29,000 men from one of the large screening studies reported last month. Only about 1 percent of those whose initial PSA test was under 1 saw their scores rise above 4 in the next five years. Those with higher baseline scores had a much greater chance of that happening.

 

"The bottom line is if you've got a PSA of less than one in your initial screen, you can wait to get another PSA for five years and not really be at increased risk of missing a cancer," he said. "If your PSA is between 1 and 2, it's also a small risk."

 

Crawford is the unpaid chairman of the Prostate Conditions Education Council, an industry-supported group that promotes screening.

 

Dr. Robert Uzzo, a prostate surgeon at Fox Chase Cancer Center in Philadelphia, said many doctors are already advising longer testing intervals.

 

"Everybody has to get screened at least at some baseline" to sort out future testing needs, he said. "If the baseline is quite low then I don't insist on yearly screening."

 

Dr. Otis Brawley, the American Cancer Society's chief medical officer, believes there is still some value to PSA testing, but added: "I am very concerned that the urology community and the American public may think there's more value in PSA than there actually is."

 

Copyright 2009 Baltimore Sun.

 

Taking a bite out of the bed-bug problem

 

Baltimore Sun staff

Baltimore Sun

Monday, April 27, 2009

 

With bed-bug infestations on the rise across the country, the Baltimore City Health Department has begun a campaign to increase awareness of the problem.

 

The department's Healthy Homes Division began conducting bedbug inspections in December and has been working with the city Housing Authority to respond to complaints and minimize infestations, says Assistant Health Commissioner Madeleine Shea. Shea says the city's 311 nonemergency number last year received 26 times more calls for bed-bug problems that it did four years ago.

 

To help combat the problem, the city has developed brochures and public service announcements and met with school health officials, In June, health workers will be conducting a door-to-door campaign to educate residents about the problem.

 

Bed bugs are small, wingless insects that feed only on blood. They prefer the blood of humans but also feed on the blood of other animals, including the family pet. Medical conditions associated with bed bugs include multiple itchy bites and inflammation, secondary skin infection, a minor potential for anemia from blood loss, minor risk of anaphylaxis, stress, anxiety and sleeplessness.

 

Residents who suspect infestations should report them immediately, Shea says. To prevent infestations in the first place, residents should never pick up discarded sofas or mattresses, she adds.

 

Copyright © 2009, The Baltimore Sun.

 

Opinion

 

Swine Flu

Human-to-human transmission has the world on alert.

 

Washington Post Editorial

Monday, April 27, 2009

 

DON'T PANIC. Yesterday's declaration of a national emergency by Homeland Security Secretary Janet Napolitano in response to the growing number of swine flu cases was a legalistic maneuver that allows local authorities access to federal aid. But Americans would do well to keep themselves informed and take common-sense precautions to limit their potential exposure to this new infectious strain.

 

The Centers for Disease Control and Prevention (CDC), the World Health Organization and the governments of Mexico and Canada are working together to understand the nature of the swine influenza A/H1N1 virus and how and where it's being spread. While much remains unknown about the virus, here's what the CDC does know: This strain of swine flu is being spread from human to human. Symptoms include high fever, cough, sore throat, muscle aches, vomiting and diarrhea. Only those who are seriously ill should get medical attention right away. The drugs Tamiflu and Relenza have been effective in treating those with H1N1. Treatment is most effective if done within 48 hours of exposure. The CDC suggests frequent hand washing; covering your nose and mouth with a tissue when you cough or sneeze; avoiding touching your eyes, nose or mouth; and staying home from work or school if you become ill. Alcohol-based hand sanitizers such as Purell are effective. There is no need for a face mask now.

 

This fast-moving health scare roared to life in Mexico around April 12, when a woman died of severe viral pneumonia. So far, more than 80 people there have died, and more than 1,300 have been afflicted. As of yesterday afternoon, there were 20 confirmed "mild" cases in the United States, with eight in New York City, seven in California, two in Kansas, two in Texas and one in Ohio. The patients range in age from 7 to 54. In a call with reporters, Anne Schuchat of the CDC announced that all 20 patients have recovered.

 

U.S. health authorities appear to have been slow to learn what was happening in Mexico. The CDC was informed by Mexican health authorities on Thursday that the cases in California were related to those in their country. The United States is not screening travelers at airports, and the Obama administration has no plans to institute the extraordinary measures taken by Mexico, which banned large public gatherings. Because the situation varies from state to state, the CDC urges everyone to consult their local governments' Web sites for up-to-date information. Updated national information from the CDC is available at www.cdc.gov/swineflu.

 

Copyright 2009 Washington Post.

 

Reforming Health Care

How a government-run plan could fit -- or not

 

Washington Post Editorial

Monday, April 27, 2009

 

OF THE many possible issues that could snarl health-care reform, one of the biggest is whether the measure should include a government-run health plan to compete with private insurers. The public plan has become an unfortunate litmus test for both sides. The opposition to a public plan option is understandable; conservatives, health insurers, health-care providers and others see it as a slippery step down the slope to a single-payer system because, they contend, the government's built-in advantages will allow it to unfairly squash competitors.

 

For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform -- changes that would expand coverage and help control costs -- without a public option.

 

President Obama has said that he favors a public option but has been sketchy on details. His nominee for secretary of health and human services, Kathleen Sebelius, said that she wants a public plan to "challenge private insurers to compete on cost and quality" but "recognizes the importance of a level playing field between plans and ensuring that private insurance plans are not disadvantaged."

 

The argument for a public plan is that, without the need to extensively market itself or make a profit, it would do a better job of providing good health care at a reasonable cost, setting an important benchmark against which private insurers would be forced to compete. Even in a system where insurers are required to take all applicants, public plan advocates argue, incentives will remain for private plans to discourage the less healthy from signing up; a public plan is a necessary backstop. Moreover, if the playing field is level, public plan advocates argue, private insurers -- and those who extol the virtues of a competitive marketplace -- should have nothing to fear.

 

We disagree. It is difficult to imagine a truly level playing field that would simultaneously produce benefits from a government-run system. While prescription drugs are not a perfect comparison, the experience of competing plans in the Medicare prescription drug arena suggests that a government-run option is not essential to energize a competitive system that has turned out to cost less than expected. Insurers and private companies have been at least as innovative as the federal government in recent years in finding ways to provide quality care at lower costs. Medicare keeps costs under control in part because of its 800-pound-gorilla capacity to dictate prices -- in effect, to force the private sector to subsidize it. Such power, if exercised in a public health option, eventually would produce a single-payer system; if that's where the country wants to go, it should do so explicitly, not by default. If the chief advantage of a public option is to set a benchmark for private competitors, that could be achieved in other ways, for example, by providing for the entry of a public plan in case the private marketplace did not perform as expected.

 

Maybe we're wrong. Maybe it's possible to design a public option that aids consumers without undermining competition. If so, we certainly wouldn't oppose a program that included a public component. But it would be a huge mistake for the left to torpedo reform over this question.

 

Copyright 2009 Washington Post.

 

Connect to protect

We must be watchful over our young neighbors, even at the risk of being intrusive

 

By Dana Burdnell Wilson

Baltimore Sun Commentary

Monday, April 27, 2009

 

What does it take to build public will to protect children? A successful campaign to address a human need or a societal problem often begins with a person, a group or a neighborhood deciding to get involved.

 

The starvation death of 2-year-old Andrew Patrick Griffin in Rodgers Forge and this month's sentencing of his parents have slipped out of the headlines in the wake of two tragic family annihilations in Maryland. These incidents could be symptoms of a level of social disconnectedness that has pervaded our society over the past few decades and continues to grow. An aspect of little Andrew's story that is particularly distressing is the reaction of the neighbors - one lamented that she had looked past signs of "children screaming for help."

 

Would being more watchful over the children in our neighborhoods protect them? This "watchfulness" may mean being more intrusive than we are comfortable with in a society that deeply values privacy. Would a shift in this aspect of our culture be worthwhile?

 

We have seen signs of success: For a dozen years, the Amber Alert program has used multiple media to ask all of us to focus our watchful eyes in the search for missing children. Community policing initiatives across the country have been initiated to prevent crime and enhance the quality of life in neighborhoods. Hot weather warnings bring public service announcements asking us to look in on our elderly neighbors. These acts not only increase safety and potentially save lives, but they also bind us as community members and enhance us as human beings.

 

Establishing a connection with our neighbors during the good times could help ease the discomfort of not "minding our own business" during questionable or bad times. We could get involved with other parents in the neighborhood, volunteer in activities in which our children participate and otherwise be part of the "village" that it takes to raise a child.

 

Minus that connection, it can be difficult to get involved. When people without a connection reach out, they can be met with defensiveness and even hostility. My colleague who called out to a little boy about to dart from between two cars into a busy street was criticized by an irate father for disciplining his child. While waiting for a MARC train, I saw a child playing on the tracks and informed his father that all of the trains did not stop at that station. He glared at me but picked up his son. A moment later, a high-speed train barreled through.

 

Although we are busy, often with both parents working and few of us living in multigenerational households, we can keep a closer eye on the children in our blocks. When suspicions arise, the next step is to become involved, either by approaching the parents or making the appropriate calls to child protective services. Watchfulness is not enough; taking action is required when it's warranted.

 

Our social disconnectedness leads to the greater tragedy of misconnections and missed connections. Help is out there for people who can connect with it. Child abuse and neglect, financial crises and substance abuse are not new problems, but how we address them as individuals and as a society needs to change.

 

Nationally recognized programs and services exist here in Baltimore. They focus on identifying effective and promising strategies for preventing child abuse and neglect, increasing protective factors and decreasing risk factors. The Family Connections program, for example, works with families to build on their strengths to address unmet needs that could lead to child abuse and neglect. Sometimes, families - even apparently successful, prosperous ones - need extra help, and being watchful and action-oriented allows us to "connect the dots" when children are at risk.

 

We can build a public committed to the safety and well-being of the children and families in our communities by having the courage to transform our watchfulness into action - by reaching out to make that connection with each other. We can make a difference.

 

Dana Burdnell Wilson is deputy director of the Ruth Young Center for Families and Children at the University of Maryland School of Social Work. Her e-mail is

 

dwilson@ssw.umaryland.edu.

 

Copyright 2009 Baltimore Sun.

 

Don't Weaken the Doctor-Patient Bond

 

Washington Post Letter to the Editor

Monday, April 27, 2009

 

Ceci Connolly's April 21 front-page article, "Health-Care Dialogue Alarms Obama's Allies," spotlighted the challenges of reshaping our health-care system. As President Obama and Congress address this issue, Americans are worried about how new laws will affect their relationships with their doctors. Any health-care debate must preserve such relationships.

 

Your doctor protects your health and wellness. Yet doctors are finding it more difficult to care for patients because of restrictions on our decision-making authority. As a urologist for more than 25 years, I have seen government, insurance companies and trial lawyers steadily erode the doctor-patient relationship under the guise of controlling costs.

 

Government constantly reduces the fees it pays doctors to treat Medicare patients. Thus, many doctors can't treat the fastest-growing segment of our population.

 

Our authority and expertise are questioned daily through "switching" -- when insurance companies pressure doctors and patients to switch from medicines that may be working well to less-expensive alternatives or cheaper drugs that have different active ingredients. For some patients that means increased risks and less effective care.

 

Doctors don't need third parties questioning the drugs we prescribe or the care we provide. I urge our lawmakers to preserve the sacrosanct doctor-patient relationship.

 

Michael R. Hardy

Fairfax Station

The writer was a trustee of Inova Health System from 2002 to 2007.

 

Copyright 2009 Washington Post.

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